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Hydroxyapatite (HA) orbital implants are made from the porous skeleton of a coral species allowing fibrovascular ingrowth, which favors tissue integration. HA (coral or synthetic) became one of the most commonly used materials for implants in anophthalmic patients in the 1990s and at the beginning of this century [9]. Synthetic HA is made of the same material, with predetermined size pores, and has become widely used in the past few years in the western countries.

A dermis fat implant (dermofat graft, DFG) is an autologous transplant consisting of de-epithelialized epidermis with its adjacent subcutaneous fat tissue. It can be used as an alternative orbital implant to alloplastic implants. Currently, it is the only autologous transplant used for this purpose in ophthalmic plastic and reconstructive surgery.

Orbital exenteration, first described by Georg Bartisch in 1583 [2], and popularized in the modern era by Arlt, is a disfiguring operation that involves total removal of the orbital contents with partial or total excision of the eyelids. Cosmetic reconstruction is a major dilemma in exenterated patients, especially in the younger age group. Eyelid-sparing techniques, retention of conjunctiva, and preservation of the periorbita are methods that have been introduced as modi- fications of exenteration in an effort to aid facial rehabilitation. The exenteration procedure can be classified as follows: • Subtotal exenteration:

In absolute tear deficiency, severe ocular surface damage can progress despite copious use of arti- ficial tear substitutes, resulting in persistent pain and permanent loss of vision [29]. In this situation, mucous membrane grafting alone will not provide sufficient lubrication to alleviate symptoms or to enable successful ocular surface reconstruction. Several studies have demonstrated that oral and nasal mucosa could successfully be used to reconstruct the fornices and provide mucin for lubrication.

The first parts of the lacrimal system develop as a cord of thickened epithelium that can be seen in the 10-mm embryo. This epithelial cord grows down into the mesenchyme without connection to the nasal mucosa or the eyelid borders.

The discipline of oculoplastic surgery has evolved dramatically over the past 10–15 years. An increased understanding of the mechanism of facial aging has necessitated an extension of surgery beyond the confines of the upper face, in order to achieve the most anatomic and harmonious facial restoration. Facial aging represents a continuum that defies segregation by arbitrary boundaries, flowing seamlessly without respect for artificial division and constructs. For many oculoplastic surgeons, the surgical alternatives for restoration of the lower face and neck are less familiar than those for upper and midfacial aging.

Often considered first-line treatment for aging skin, soft tissue fillers are used alone or in combination with other rejuvenation procedures to correct wrinkles, improve facial contours, and restore volume naturally lost as fat diminishes from the face, particularly around the eyes and cheeks. Until recently, it was believed that sagging skin was due to gravity, but new evidence points to the atrophy of subcutaneous soft tissues – allowing unsupported skin to fall into wrinkles and folds – as the cause and suggests that a redistribution of fat or volume replacement may restore vitality [2, 5, 14, 16–18].

The skin takes center stage in the fight against aging. While the number of cosmetic surgery procedures continues to increase, the vast majority of this increase consists of minimally invasive procedures. Furthermore, patients are beginning to understand the importance of addressing the skin as part of their total facial rejuvenation plan. Surgical procedures only tighten or lift the skin, thus failing to address any photodamage or other flaws that may be present. To optimize surgical outcomes or to improve upon nonsurgical options, the skin must be addressed as an important component of the treatment plan.